Embattled

April 17, 2020

Dear Members:

The level of disruption in our lives and the “new normal,” doesn’t feel normal at all. We are more familiar than we ever wanted to be with things like PPE, doubling times, burnout rates, the impact of testing and isolation and the emerging data on flattening the curve.
 
We are working from home, social distancing in our offices, preparing for the pandemic and trying to find ways to keep our practices viable, as well as our families and ourselves safe. We are dealing with the grief of laying off staff and closing clinics. We are anxiously being reskilled for COVID-19 teams.
 
Thanks to the enormous efforts of many, Albertans may be spared the extreme effects of this deadly virus. Thank you to our public health leaders, in particular our Chief Medical Officer of Health, Dr. Deena Hinshaw. Thank you to Alberta Health Services CEO, Dr. Verna Yiu and to the many doctors and health care workers at AHS. And thank you to our government, who have supported medical expertise to prevail as the key determinant of our province’s direction in this crisis.
 
It is worth reflecting on a question posed by Dr. Christopher Doig, past AMA President, “During COVID-19 we trusted our health care experts, should we not do that at all times?”
 
In the midst of all this, the AMA has not lost sight of our mandate to support you and, in doing so, support health care in Alberta. We are actively involved on multiple fronts.

Supporting physicians during the COVID-19 pandemic

In recent weeks AMA has offered webinars on virtual codes and business continuity. These have been recorded and are available on our Webinars & Online Learning page. 

We have launched a public awareness campaign, Share the Care/#StayHealthyAB, aimed at supporting and connecting with Albertans. It is one way of letting them know that their family and community-based physicians are available to meet their needs either with virtual care or special in-person arrangements that are COVID-19 safe. Over 45,000 Albertans visited the campaign landing page in this first week of an eight-week campaign, and over 9,000 engaged and completed an activity.
 
The Community Support Group is meeting weekly with a focus on identifying and supporting the needs of community physicians to provide care during the pandemic on issues such as PPE, communication, technology and quarantine. Thank you to Alberta Health for chairing this important group which includes the AMA, AHS and the College of Physicians and Surgeons of Alberta. 
 
AMA’s economics group has developed and advanced to government a proposal for an infrastructure stability plan. This is in recognition that physician services are deemed essential services and, as such, this vital infrastructure needs to be supported for Albertans. Our proposal is designed to support both hospital and community-based practices. Similar types of programs have been implemented by Newfoundland, Nova Scotia and Saskatchewan. 
 
This support is particularly critical in Alberta where physicians are in a uniquely disadvantaged position with the funding changes resulting from the government’s April 1 imposition of the Physician Funding Framework. This proposal is currently with the Minister for consideration. I have written to him requesting urgent attention to this matter.
 
Yesterday government and AHS announced a “clinical alternative relationship plan” for AHS physicians who are being deployed to provide COVID-19 care. It provides a non-fee for service option, essentially a sessional rate, for AHS physicians who volunteer to change their practice at this time to care for pandemic patients. The AMA has previously submitted a proposal for these situations. Although this was not the model that AH and AHS eventually chose, the payments are not dissimilar. We continue to advocate for differential increased compensation for extreme high risk situations.
 
Last week the Board met with senior Alberta Health and AHS leaders to discuss how to align our various capabilities and activities at the provincial level. While the AMA will continue to support community-level decision-making in the pandemic through the Community Support Group, we have also proposed establishment of a Physician Advisory Committee to provide broad input. I hope to hear soon that this will be moving forward.

Practice survival post-April 1

So many physicians have contacted me with details of the severe, compounded burden of COVID-19 and the impact of the imposed Physician Funding Framework. In the midst of a pandemic, with significantly reduced patient volumes, members are also dealing with decreased remuneration and practice changes resulting from the reduction in Medical Liability Reimbursement and reduced payments for AHS consultative care, among others.
 
AMA was clear with government about the inevitable downstream consequences of their Physician Funding Framework. We have not ceased efforts to have these changes suspended. Increasingly, members are giving notice that when the pandemic is over, they will withdraw from services they can no longer afford to offer. The AMA respects the right of all physicians to make such choices, in accordance with professional ethics and the standards and advice of the CPSA. We will support the actions of our colleagues who find themselves in these heart-wrenching situations. 

Member Survey and Virtual Representative Forum 

In this complex and disruptive time, the Board needs to hear from the profession to guide our decisions. To enable this, we have reached out in several ways.
 
You’ve recently received a member survey and we have received over 2,500 completed surveys thus far. The preliminary results are very helpful. The survey closes next week, so if you haven’t already done so, please complete the Member Survey to help us understand your position on current issues. Please note that the survey closes at 5 p.m. on Tuesday, April 21. 

Our spring Representative Forum was cancelled due to COVID-19, but due to the ingenuity of the AMA staff, we held a virtual RF last Wednesday evening. Thank you to the 114 RF delegates who participated.
 
The Board is currently holding virtual fan-out sessions with small groups of RF members. These meetings are an interactive format to inform positions on the critical questions we are facing. This input will be compiled for the Board and shared back to the RF delegates. The topics being considered and discussed are:

• COVID-19 and related support; 
• management of the Physician Services Budget; 
• Physician Funding Framework issues; 
• physician payment reform and clinical ARPs; and 
• public positioning of the AMA. 

These activities will help the Board understand how best to represent and support the profession while reflecting our values and goals to the public and the government. 

Remembering why it matters

Yesterday the AMA received a delightful email from the grade 7 and 8 students at Svend Hansen K-9 School in Edmonton. About 60 of those students had created digital thank you cards to health care workers in their community. You can view and enjoy these wonderful wishes yourselves. Physicians are only one part of the team, of course, so we will be passing this on to the College and Association of Registered Nurses of Alberta, the Alberta Pharmacists’ Association and others. I hope you will enjoy this reminder of why what we do matters at the end of the day.
 
In closing, we have a responsibility to speak out when our health care system is threatened. Your stories and comments are a source of inspiration and hope to me and for our future together.

In your service

Christine P. Molnar, MD, FRCPC
President, Alberta Medical Association